It's Enough To Make You Sick

In days long past, relief of acid indigestion was a relatively simple matter. We ladled on the chili, dug into pepperoni pizza, and topped it off with Aunt Leona's killer brownies, secure in the knowledge that our Tums or Alka-Seltzer were waiting patiently in the medicine cabinet. Oh, what a relief it was.

Now, drug goliaths are pelting consumers with a slew of reformulated big-time prescription remedies. Pepcid AC and Tagamet HB have arrived. Zantac is coming. And the ad climate is getting ugly. "If the public could actually see and make sense of the data on which these claims are based, they would be appalled at how trivial the differences are," says Dr.

Jerome L. Avorn, an associate professor at Harvard Medical School. "It's all puffery."

Or worse. On Sept. 5, Johnson & Johnson-Merck, the joint venture that produces Pepcid AC, sued SmithKline Beecham, maker of Tagamet HB. J&J-Merck alleges false advertising, citing SmithKline's claims that Tagamet HB works much faster. Smith-Kline had sued J&J-Merck on Aug. 25, citing boasts so bald as "New Pepcid AC is better than Tagamet HB."

VIRTUAL TWINS. Certainly, the pharmaceutical world has seen this sort of fracas before. With the introduction of two major acid indigestion products and more on the way, though, the OTC wars have reached a new frenzy. Drugmakers are spending more than $250 million to sell their wares to the 61 million Americans with occasional heartburn, a market worth well over $1 billion a year. All that money, say critics, forces queasy consumers to sort through irrelevant or misleading ads. J&J-Merck's ads claim "Only Pepcid AC has proven that it can prevent heartburn and acid indigestion." SmithKline trades on Tagamet's history as a prescription ulcer-fighter--a far cry from its weaker over-the-counter version.

Many doctors contend that, ultimately, the OTC forms of Pepcid and Tagamet simply are not much different. Both so-called H2-antagonists inhibit the production of stomach acid, not just absorb it, as antacids do. "These drugs are virtually the same," says Dr. M. Michael Wolfe, an associate professor of medicine at Harvard and co-author of The Fire Inside, a gastrointestinal guide due out in February. "The differences are not clinically relevant."

For marketers, though, it's crucial to fix the idea of product superiority early on--as SmithKline learned when rival Glaxo Inc. convinced doctors in the mid-1980s that its prescription ulcer-fighter Zantac outperformed Tagamet. Although almost identical, Zantac soared above Tagamet to become the biggest-selling drug in the world, racking up $3 billion in annual sales. Indeed, the ad battle among H2-blockers will heat up when Glaxo and marketing partner Warner-Lambert Co. take Zantac over the counter, perhaps later this year.

Already, the battle is forcing OTC marketers to do some fancy dancing. J&J-Merck must pitch its Pepcid AC without killing off its Mylanta antacid. So, while vaunting Pepcid AC's advantages in one set of ads, J&J-Merck claims in others that "nothing soothes heartburn faster than Mylanta liquid." SmithKline, for its part, shuns attacks on antacids such as its Tums in promoting Tagamet HB. That's likely a sound strategy, since it and the other combatants probably will end up marketing their H2-blockers in combination with an antacid. More to the point, doctors say that Tums, Mylanta, and Maalox provide almost immediate relief, even if slower-acting H2-blockers ease discomfort longer.

What doctors think, though, may not matter on Madison Avenue. "If you're targeting doctors or the medical community, the advertising may frankly not be credible," says Gary M. Stibel, a principal at the New England Consulting Group. But he adds: "Doctors are very naive in believing that small differences between products cannot be meaningful to consumers." In the end, he says, what matters is "what real consumers believe is important." Look for more advertising heartburn to come.


Competing claims in ads for Pepcid AC and Tagamet HB and a doctor's reaction:

PEPCID AC "Only Pepcid AC has proven that it can prevent heartburn and acid indigestion. Only Pepcid AC controls acid with just one tablet. Only Pepcid AC is preferred by 8 out of 10 doctors and pharmacists."

TAGAMET HB "Doctors have already endorsed Tagamet in the strongest possible way. With their prescription pads. And now doctors and pharmacists will appreciate Tagamet HB's onset-of-action for heartburn. Pepcid AC, on the other hand, can take one to two hours to start reducing stomach acid."

M. MICHAEL WOLFE, HARVARD MEDICAL SCHOOL "These drugs are virtually the same." And neither acts as quickly as such antacids as Tums or Mylanta.

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